Is pregnancy safe with lupus nephritis and Mycophenolate?

Question

Hello doctor,

I am worried about my lupus nephritis diagnosis from two months ago. My rheumatologist started me on Prednisone (40 milligrams daily) and mycophenolate mofetil (CellCept), but my menstrual periods have completely stopped, and I am only 28. The facial swelling and weight gain (15 pounds in six weeks) are making me feel very self-conscious, and my husband keeps asking when I will look normal again. My serum creatinine level has improved from 2.1 to 1.8 milligrams per deciliter, which is encouraging, but my blood pressure remains elevated at 160/95 millimeters of mercury, even while taking Lisinopril. I also continue to have joint pain in my hands, which makes it difficult to change my 18-month-old daughter’s diapers. I feel exhausted all the time. My most recent urine test still showed 3+ protein and the presence of red blood cells. We had been trying to conceive our second child before my lupus worsened, but now I am wondering if pregnancy is even safe with lupus nephritis. Should I stop taking mycophenolate mofetil if we want to try for a baby, and what other treatment options are available?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Firstly, it is encouraging that your serum creatinine level has improved, which suggests some response to treatment. However, the ongoing proteinuria and elevated blood pressure indicate that your lupus nephritis remains active and requires close monitoring. High blood pressure also increases the risk of both kidney function and any future pregnancy. Mycophenolate Mofetil (MMF) is not considered safe during pregnancy, as it carries a high risk of birth defects and miscarriage. If you are seriously considering pregnancy, you will need to discuss transitioning to a safer alternative, such as Azathioprine, which is generally considered compatible with pregnancy when used under specialist supervision.

The absence of menstrual periods may be linked to physical stress on your body, medication effects (such as Prednisone), or hormonal imbalance from high-dose corticosteroids.
This may improve as your treatment is reduced and your condition becomes more stable.
If your cycles do not return, a check of your reproductive hormone levels may be needed.
Weight gain, facial swelling (moon face), and fatigue are common with high-dose Prednisone but often improve as the dose is lowered.
Your feelings of distress, especially while caring for a toddler, are completely valid.
You are managing a serious illness, and it’s important to seek both emotional and practical support.

It is important to talk to your rheumatologist about long-term pregnancy planning and the possibility of transitioning to pregnancy-safe immunosuppressive therapy, such as Azathioprine, but only after your lupus nephritis is stable. Before trying to conceive, it is essential to work closely with a maternal-fetal medicine specialist who can help guide you through the safest approach to pregnancy with lupus. Controlling your blood pressure tightly is also crucial, which may require adjusting your current antihypertensive medications to achieve better stability. Additionally, speak with your doctor about the potential to taper your dose of Prednisone as your disease activity permits, which could help reduce the burden of side effects such as weight gain and fatigue. Emotional and psychological support is equally important. Do not hesitate to reach out to a counselor or consider joining a support group, as systemic lupus erythematosus affects both physical health and personal identity. You are doing your best in incredibly challenging circumstances, and your care plan must support not only your medical needs but also your quality of life and future goals.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.